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ADOLESCENT RESEARCH DIVISION

Linda-Gail BekkerChief Operating Officer

Thola BennieAdolescent Research Manager

Dr Millicent AtujunaSocio-behavioural Scientist

Prevention

Adolescents in South Africa remain at the centre of the HIV/AIDS epidemic in terms of infection rates, vulnerability and impact. HIV incidence rates in South African women peak in the 15-24 age group, with recent statistics indicating an incidence of 2.54 in females and 0.55 in males in this age group (Shisana et al; 2014). Reasons for this increased risk include high levels of sexual risk behavior, transgenerational and transactional sex, as well as gender-based violence.

 In addition, adolescents have unique psychosocial, cognitive, physiological, and neurological developmental issues, and thus urgently require targeted, innovative, and responsive HIV prevention products and interventions that address their needs and help to reduce their risk.

 Several projects at DTHF are currently underway to achieve this at the Masiphumelele Youth Centre.

 Choices for Adolescent Methods of Prevention Studies in South Africa

CHAMPS

In the context of emerging evidence for efficacy and adaptability of various biomedical HIV prevention options and their appropriateness for adolescents, the CHAMPS project follows a novel approach to combining different HIV prevention strategies into an optimized prevention ‘menu’, from which young women and men at risk of HIV infection may choose a particular combination of strategies to meet their specific needs and circumstances. The CHAMPS project is comprised of four pilot studies rolled out as a series of interrelated protocols. Each study will examine specific questions or research gaps related to adolescents (ages 14-19 years old) and feasibility and acceptability of biomedical prevention options. The studies are as follows:

  1. “MACHO”: male circumcision
  2. “Pluspills”: oral Pre-exposure prophylaxis (PrEP)
  3. “UChoose”: modes of PrEP delivery (injectable, oral and vaginal ring)
  4. “iChoose”: adolescent decision-making about prevention

The MACHO (Males Actively Choosing Healthy Options) study, examining acceptability of medical male circumcision as an HIV prevention method in two communities is underway and is fully enrolled, with 100 adolescent boys aged 14 to 17 years and their parents participating.

Pluspills is the first adolescent PrEP study to be conducted in adolescent females globally and will examine the feasibility, acceptability and use of oral PrEP in 150 adolescent girls and boys aged 15 to 19 years.

UChoose is examining female preferences for method of PrEP delivery through the use of different contraceptive options (oral, injectable and vaginal ring) in 150 adolescent girls aged 16 and 17 years.

The findings from the three pilot studies will feed into a fourth study that will examine adolescents’ decision making around HIV prevention, the efficacy of a ‘menu’ approach for HIV prevention options, and the impact of messaging about each option on the adolescents’ selection. This will have a large social marketing component: “iChoose”.

In addition, a modelling and costing component of this project will determine the impact of implementation of these prevention methods in South Africa on the South African adolescent epidemic, as well as the cost implications.

An examination of the ethico-legal challenges surrounding research on and implementation of biomedical prevention strategies in adolescents also forms a part of this project and is being led by the HIV AIDS Vaccine Ethics Group (HAVEG) at the University of KwaZulu Natal in collaboration with DTHF.

PI: Professor Linda-Gail Bekker

Project Manager: Dr Melissa Wallace

Study Manager: Thola Bennie

Human Papilloma Virus (HPV) Genotyping

Persistent infection with HPV (more common in those who are HIV-infected) is linked to cervical cancer and the outcomes have implications for managing care of HIV-positive young women.

This observational study, conducted in collaboration with Dr David Adler of the University of Rochester, NY, therefore aims to assess differences in HPV types and persistence in 50 HIV-positive and 50 HIV-negative adolescent girls. This study is fully enrolled and will monitor participants over a four year period.

PIs: Assoc. Professor David Adler and Professor Linda-Gail Bekker

Project Manager: Dr Melissa Wallace

Study Manager: Thola Bennie

Women’s Initiative in Sexual Health (WISH) Study

A basic science mucosal study is also underway, examining factors affecting HIV susceptibility in the adolescent genital tract. 150 young women aged 16 to 22 will be enrolled and followed for 6 months.

PI: Dr Jo-Ann Passmore

Co-investigator: Professor Linda-Gail Bekker

Project Manager: Melissa Wallace

Study Manager: Thola Bennie

Treatment

HIV-positive infants born to women with HIV infection prior to the availability of PMTCT in South Africa are now surviving into adolescence. The increasing availability of ART has afforded them longer survival, and modeling predictions indicate a substantial and prolonged emergent epidemic of HIV/AIDS in older children and adolescents (Ferrand et al; 2009). With unprecedented survival rates in this group comes a growing need for greater understanding of disease progession in this group.

CTAAC (2013-2017)

The Cape Town Adolescent AIDS Cohort study in collaboration with a multidisciplinary primarily UCT-based team aims to investigate markers of chronic disease processes and progression in perinatally HIV-infected SA adolescents in four key areas (general adolescent development; neurocognitive function; pulmonary disease; cardiovascular function). HIV-positive adolescents are being recruited from the adolescent clinic to participate This is a prospective, descriptive cohort study of 520 HIV positive adolescents on ART, aged 9 to 14 years, followed for 3 years. We are recruiting HIV positive adolescents from our adolescent clinic at the Hannan clinic in Gugulethu, as well as a matched control cohort of 100 HIV negative adolescents through our Youth Centre in Masiphumelele.

PI: Heather Zar

Co-investigator: Professor Linda-Gail Bekker

Project management: Dr Melissa Wallace, Dr Millicent Atujuna and Thola Bennie

PhD research

Thola Bennie is conducting her doctoral research in the area of adherence to HIV prevention modalities. For this she is investigating barriers to adherence to study product, taking lessons from the VOICE study and applying them to adolescent studies in an effort to understand the specific challenges that adolescents face and what adherence can be improved in the adolescent population.

Adolescent Programmes

Youth Development and Transition Programme

HIV-positive infants born to women with HIV infection prior to the availability of PMTCT in South Africa are now surviving into adolescence. The increasing availability of ART has afforded them longer survival, and modeling predictions indicate a substantial and prolonged emergent epidemic of HIV/AIDS in older children and adolescents (Ferrand et al; 2009). With unprecedented survival rates in this group comes a growing need for a systematic model to transition adolescents to adult care whilst ensuring adherence to care and treatment. There is evidence that adolescents are particularly vulnerable to defaulting on treatment and care as they transition to adult care. Notably, there is little research on this and no clear guidance on how or when this process should occur.

During 2013, the adolescent division of the DTHF has conducted formative research with HIV-positive adolescents and young adults, as well as HIV healthcare providers in order to identify key challenges to successful transition. This has informed the development of a youth development programme to facilitate adolescent transition to adult healthcare and provide adolescents with key development skills through a curriculum based programme using cognitive behavioural tools. This will be initiated and evaluated in 2015.